What is the role of cystoscopy in the surveillance for recurrent bladder cancer?

Updated: Sep 10, 2019
  • Author: David A Levy, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Instilling 5-aminolevulinic acid into the bladder a few hours prior to cystoscopy allows accumulation in malignant sites often not visible during white-light (normal) cystoscopy. When illuminated with a light ranging from 375-445 nm, up to one fourth of small malignant areas may be missed during routine cystoscopy. This has been proven by biopsy studies.

Of concern is that these areas may be more likely to harbor higher-grade cancer than those identified otherwise. Carcinoma in situ (CIS) is missed by conventional cystoscopy 22% of the time.

Halling et al similarly found a significant number of cancers that cystoscopy failed to definitively identify. [6] This draws into question whether early recurrences are truly recurrent cancer or simply incompletely removed cancer.

A multicenter study of 304 patients at high-risk of recurrance underwent blue-light (fluorescence) cystoscopy (BLC), which uses a photosensitizer (5-aminolevulinic acid or hexaminolevulinate) instilled in the bladder 1 to 3 hours prior to cystoscopy, showed improved detection of bladder tumors independent of tumor stage (Ta, T1, and Tis), risk category (low, intermediate, and high) compared with WLC. The improved detection rate was most pronounced in Tis tumors (34.6%; odds ratio, 95% CI, 17.2-55.7, p < 0.0001).  [10]

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